Scott Webb (Host): Colon cancer is one of the deadliest cancers in America, but it's also one of the most preventable. Dr. Narayan Prabhakar is here again today. He's a Board Certified Family Medicine physician practicing at Franciscan Health, and he's going to tell us more about colon cancer, who's at the highest risk, and encourage us all to be screened. This is the Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, it's great to have you on again. We talked about shingles recently and how folks should try to avoid shingles and get the shingles vaccination. Today we're going to talk about the best defenses against colon cancer. And I just want to have you start by explaining colon cancer to listeners, maybe some of the stats on who's most affected by it and why it's so deadly.

Narayan Prabhakar, MD: Colon cancer is one of the leading causes of death amongst men and women in the U.S. Some years it's number two leading cause, some years it's the third leading cause of cancer death. So it's up there and it's highly preventable. You know, there's certain things that can be done to lessen your chances, so we're going to discuss that. A lot of it has to do with getting screened. Lifestyle changes is what I'm going to go into, which is pretty much the crux of it. Number one thing to check for colon cancer, we have a few different ways to check for colon cancer, that have been proven over time.

The gold standard still is the colonoscopy that you will do every 10 years starting at age 45 now, if you're at average risk. That is still the gold standard. That is still the way to go. And if it's normal and they find nothing wrong in there, no polyps, then it's every ten years. Typically, you go until about age 75.

After that, it just depends on the conversation you have with your physician or if there was a previous polyp that needed to look into. Typically, you start at 45 and you go until 75 for people with average risk. Now, of course, if it runs in your family or if you have sort of certain genetic conditions, then you may even start earlier than 45. You may start at age 40 or 10 years earlier than the youngest person in the family, first degree relative that was diagnosed. That is the number one way to prevent and or catch colon cancer early. There's some other options as well. We got the Cologuard, that I think everyone's heard of. It's a lot more convenient, of course.

With that one though, it's maybe three years. It is 92 percent accurate. And of course, if that's positive, then you can follow that up with a colonoscopy. The benefit is, you know, you do it at home, it's discreet, but it's every three years. But colonoscopy, I would still, would be my number one option. It's 10 years, you're done.

Host: I think one of the tricky things, sure, folks need to know their risk factors and listen to their providers, of course, but one of the tricky things about colon cancer maybe is that there aren't a lot of early signs and symptoms. Do I have that right? Like, you're not going around thinking, you know, I might have colon cancer. Like, you really do need to be screened. So maybe you can, if there are any early signs and symptoms, what are they?

Narayan Prabhakar, MD: More than likely, sometimes you get some blood in the stool. You could get weight loss, fatigue for no reason, change in your bowel habits. Those are usually the most common things that you might have, or in some cases you don't have any symptoms at all, so.

Host: Right, and of course, as you know, I don't need to tell a doctor this. A lot of those signs and symptoms you were just mentioning there, those could be colon cancer or could be a bunch of other stuff too. Losing weight, fatigue, you know, those kinds of things. So, always good to speak with providers, of course, and clarify and be screened.

Let's talk a little bit more about the risk factors, and I think maybe we could stress the importance of knowing your family history, but are some folks just going to be more prone to colon cancer because of family history and genetics and their risk factors? Is that how that works?

Narayan Prabhakar, MD: Yeah, so I mean if you have a personal history of, for instance, certain inflammatory bowel disease like Crohn's, ulcerative colitis, or if you have a family history of colon cancer, polyps, or there's a few different genetic conditions out there; those were the main things that would definitely, in those situations, you would just do a colonoscopy every 10 years, or starting at 45, probably even earlier. In those folks, you wouldn't bother with a Cologuard or any other test out there. You would go right to the colonoscopy, in those situations.

Host: Yeah, and as you said, the screening guidelines have changed, used to be 50 was, was the kind of like the gold standard, the that's when everyone would start, now it could be 45, it could be earlier, if you do have a family history, and you know, we talked about the importance of colonoscopies still being the gold standard, so, rather than going back over that, I wanted to have you maybe just take folks through the process a little bit. Having had colonoscopy myself, I know that the prep is a little easier, a little better than it used to be, but just generally what's involved from the prep all the way till when they're done with the colonoscopy. If you could take us through that.

Narayan Prabhakar, MD: Yeah, absolutely. I've had it done myself, when I turned 50, it was not as painful as I would think. The prep has certainly gotten better compared to before. There was a time when you had to drink this huge gallon of liquid, it was called Go Lytely, but the prep now is even better.

 Of course, you still have to do the prep because if your bowels aren't cleaned up, then they cannot see well. Then you have to go again or it's inconclusive, which you don't want. So you do have to do a prep, but they have different options now. The prep I had to do was a lot, lot easier to do. It was, I think the night before you had to do it. And then you go in the next morning. You don't eat or drink anything after a certain time, just like any sort of surgery, but it's not considered surgery, it is considered a procedure. So you go in, it's usually done in the hospital setting or like a surgery center kind of a setting.

You don't need to be put to sleep, you're usually just sedated, which is just fine. If you're relaxed, you might fall asleep, you might be out of it. And it's a pretty fast procedure. The actual time it takes to do the colonoscopy is probably 15 to 20 minutes, maybe 30 minutes tops if takes a little longer in some situations, you know, for instance, if you're not cleaned up well. If you didn't finish the bowel prep successfully, you know, depending on the anatomy of your colon, sometimes it might take a little longer, but usually about 20 minutes and you're done. Then, just like with any sort of surgery, you're back in the recovery room.

They just need to make sure you recover fine. And if they had to take out any polyps, then they'll let you know. Then when they send the polyps for what's called a biopsy to make sure it's not cancer. And if they turn out to be simple polyps, then you may end up just needing to repeat the colonoscopy in 10 years.

If the polyp turned out to be something a little bit more, let's say, maybe worrisome, then they may tell you, depending on the size of the polyps, depending on the number of polyps, characteristics of the polyps, it could be even three years, three to five years. You may have to go back and get the colonoscopy done. And then you pretty much go home the same day.

Host: Right. Yeah, you need someone to drive you, of course, right. need

Narayan Prabhakar, MD: Someone's got to drive you home. You would take it easy the rest of the day. You're going to feel a little sedated. You may have a little bit of rectal discomfort for a day or two. And that's about it. It's a pretty simple procedure.

Host: Yeah, having been through it twice, the one with the old sort of prep, the amount of prep, and then the more recent one, yeah, I would say it's improved, there's a lot less that you have to intake, as you say, it's relatively easy, quick process, it's the best nap I think you'll ever have, you know, that 20 minutes or so.

Narayan Prabhakar, MD: Oh, absolutely.

Host: Yeah, so every good reason, especially because it is still the gold standard to be screened because it is one of the leading causes of death to try to prevent, obviously, getting colon cancer, but for those who even have the most diligent ones, let's say they end up developing colon cancer; briefly here, what are some of the treatment options? What do you do when someone, if one of those polyps does not come back negative, if you will?

Narayan Prabhakar, MD: Treatment options wise, you know, usually at this point, if it turns out to be colon cancer, we would refer you to a oncologist. They would first need to do different things to test, to stage, to make sure, you know, see how much it's spread, how little it's spread. That also depends on what they can do in terms of chemotherapy and radiation and things like that.

Host: Right. So obviously the whole point of the colonoscopy is to be screened and you want those biopsies to come back negative. But if they do come back positive, then it becomes a whole other thing, which we don't really have to get into today. But there are lots of options. These multidisciplinary teams that will work with you, in terms of figuring out, as you say, staging and all of that. Has it spread? What to do next? This has been really good stuff today. Just give you a chance here, Doctor, at the end, stress again, for folks, the importance of screening for colon cancer as our best defense.

Narayan Prabhakar, MD: The earlier you can catch it, the better. With any cancer for that matter. And that's the key and also we didn't get a chance to touch on some of the other lifestyle changes you can make to lessen your chance. For instance, eating a diet high in fiber, high in grains, cutting down your alcohol use, smoking definitely increases your chances of getting colon cancer as much as a sedentary lifestyle.

So you want to stay active, eat healthy. Try to avoid eating too much red meat, try to make sure you're getting a balanced diet high in fruits, vegetables, and fiber, cutting down on alcohol use, and stop smoking, completely. Those would help as well.

Host: Yeah, that's perfect. You know, knowing your family history, genetics, behavior, lifestyle changes, get screened, get that colonoscopy, great stuff again today, Doctor. Just appreciate your time. Thank you so much.

Narayan Prabhakar, MD: Great. Thank you.

Host: And for more information, visit franciscanhealth.org and search colon cancer. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.